Impaired Postural Balance in Turner Syndrome

Abstract

An impaired body balance has been found in Turner syndrome (TS) in clinical tests like Rombergs’s test and walking on a balance beam. The aim of the study was to assess postural balance in TS subjects with specific balance testing using dynamic posturography and relate to body composition. Nineteen TS subjects (20–57 years) were included. Balance was measured with dynamic posturography (Equitest) and compared with 19 sex and age-matched controls (22–59 years). Equitest, visual, vestibular, and somatosensory systems were provoked with increasing difficulty (6 tests, SO1–SO6) and body sway was measured with a dual forceplate. Body composition was measured with DXA. No difference was found between the TS subjects and the controls on fixed platform with open eyes (SO1), with closed eyes (SO2), with stable platform and visual disorientation (SO3), or on unstable platform with open eyes (SO4). In the difficult tests on unstable platform the TS subjects did worse compared with controls both in the test with eyes closed (SO5), p<0.01, and in the test with visual disorientation (SO6), p<0.05. Composite (a merge of all six recordings) was significantly lower in the TS-group, p<0.05. In the TS group high total body weight was related to worse outcome on tests SO5, SO6, and composite, while total bone mass, age, height, or waist showed no significant association with balance scores. Our findings indicate that TS could have an increased risk for falling due to impaired ability to manage complex coordination tasks.

Key words

oestrogen deficiency - Turner syndrome - balance - posturography - body weight

• References

• 1 Bakalov VK, Bondy CA. Fracture risk and bone mineral density in Turner syndrome. Rev Endocr Metab Disord 2008; 9: 145-151
• 2 Landin-Wilhelmsen K, Bryman I, Windh M, Wilhelmsen L. Osteoporosis and fractures in Turner syndrome – importance of growth promoting and oestrogen therapy. Clin Endocrinol (Oxf) 1999; 51: 497-502
• 3 El-Mansoury M, Barrenas ML, Bryman I, Hanson C, Landin-Wilhelmsen K. Impaired body balance, fine motor function and hearing in women with Turner syndrome. Clin Endocrinol (Oxf) 2009; 71: 273-278
• 4 Nashner LM, Peters JF. Dynamic posturography in the diagnosis and management of dizziness and balance disorders. Neurol Clin 1990; 8: 331-349
• 5 Hammar ML, Lindgren R, Berg GE, Moller CG, Niklasson MK. Effects of hormonal replacement therapy on the postural balance among postmenopausal women. Obstet Gynecol 1996; 88: 955-960
• 6 Brown WE, Kesler SR, Eliez S, Warsofsky IS, Haberecht M, Patwardhan A, Ross JL, Neely EK, Zeng SM, Yankowitz J, Reiss AL. Brain development in Turner syndrome: a magnetic resonance imaging study. Psychiatry Res 2002; 116: 187-196
• 7 Isles RC, Choy NL, Steer M, Nitz JC. Normal values of balance tests in women aged 20-80. J Am Geriatr Soc 2004; 52: 1367-1372
• 8 Baloh RW, Fife TD, Zwerling L, Socotch T, Jacobson K, Bell T, Beykirch K. Comparison of static and dynamic posturography in young and older normal people. J Am Geriatr Soc 1994; 42: 405-412
• 9 Kingma H, Gauchard GC, de Waele C, van Nechel C, Bisdorff A, Yelnik A, Magnusson M, Perrin PP. Stocktaking on the development of posturography for clinical use. J Vestib Res 2011; 21: 117-125
• 10 Buatois S, Gueguen R, Gauchard GC, Benetos A, Perrin PP. Posturography and risk of recurrent falls in healthy non-institutionalized persons aged over 65. Gerontology 2006; 52: 345-352
• 11 Whitney SL, Marchetti GF, Schade AI. The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders. Arch Phys Med Rehabil 2006; 87: 402-407
• 12 Baloh RW, Corona S, Jacobson KM, Enrietto JA, Bell T. A prospective study of posturography in normal older people. J Am Geriatr Soc 1998; 46: 438-443
• 13 O’Neill DE, Gill-Body KM, Krebs DE. Posturography changes do not predict functional performance changes. Am J Otol 1998; 19: 797-803
• 14 El-Kahky AM, Kingma H, Dolmans M, de Jong I. Balance control near the limit of stability in various sensory conditions in healthy subjects and patients suffering from vertigo or balance disorders: impact of sensory input on balance control. Acta Otolaryngol 2000; 120: 508-516
• 15 Ledin T, Kronhed AC, Moller C, Moller M, Odkvist LM, Olsson B. Effects of balance training in elderly evaluated by clinical tests and dynamic posturography. J Vestib Res 1990; 1: 129-138
• 16 Ross JL, Roeltgen D, Feuillan P, Kushner H, Cutler Jr GB. Effects of estrogen on nonverbal processing speed and motor function in girls with Turner’s syndrome. J Clin Endocrinol Metab 1998; 83: 3198-3204
• 17 Gravholt CH, Hjerrild BE, Mosekilde L, Hansen TK, Rasmussen LM, Frystyk J, Flyvbjerg A, Christiansen JS. Body composition is distinctly altered in Turner syndrome: relations to glucose metabolism, circulating adipokines, and endothelial adhesion molecules. Eur J Endocrinol 2006; 155: 583-592